Ask the Doctor: ‘Are physiotherapy exercises important post-knee replacement?’

“My father who lives with me is going in for a knee replacement soon. He had the other done a couple of years ago and wasn’t the most diligent when it came to continuing his prescribed physiotherapy exercises once he came home. For this reason, we have booked him in for convalescence for a week after he is discharged. Also, I would like to help encourage him to keep up his exercises once he gets back home. Just how important are these to his recovery and any tips on what I can say to encourage him to keep them up?”

Answer from Ian Byrne, Allied Therapies Manager, Beacon Hospital

The problem of a lack of adherence to rehabilitation instructions and exercise is an age-old problem for rehabilitation professionals and one that provides an exciting avenue for researchers and professionals alike. Multiple qualitative studies have examined this area with common intrinsic and extrinsic barriers identified.

Intrinsic barriers include patient’s understanding of their condition/surgery, history of physical activity participation, pain and time constraints, while extrinsic factors include ease of access to care, social support and everyday considerations like weather and equipment. Interventions such as wearable technologies, activity trackers, telehealth and publicly funded exercise-based initiatives have all looked to help reduce the impact of the problem.

Exercise based rehabilitation is seen as a fundamental aspect of the patient’s total knee replacement journey and helps to limit poor post-surgical outcomes such as muscle weakness, reduced range of motion, reduced function and pain. Poor adherence to healthcare provider’s instructions around rehabilitation have been linked to these poor outcomes but thankfully there is plenty of help on hand to help your father on his journey.

Prior knowledge of the process from the previous knee replacement will arm him with the knowledge of what the process requires and set a level of expectation regarding the post-surgery pathway. Your social support will be key as will the access to care he will hopefully receive in convalescence. In terms of what you can say, the best intervention here is encouragement towards engagement with professionals and ongoing general encouragement to promote adherence.

The key component, in my experience, is early engagement with appropriately qualified healthcare professionals well in advance of the surgery to provide education, manage expectations and familiarise patients with what is to come. All of this serves to empower the patient to control their situation and actively participate in their care. Here at Beacon Hospital we have a robust offering, including nurse led pre-assessment clinics, pre-operative education and exercise based classes to familiarise patients with the required exercises and help to arm them with the knowledge to work towards a favourable outcome.

Equally beneficial is engagement with a local chartered physiotherapist, experienced in orthopaedic rehabilitation, who can guide your Father through the journey. Post operatively, group-based exercise is known to have a positive impact on adherence, perhaps due to the social support it can provide. At Beacon hospital we see patients really benefit from group-based rehabilitation classes and this option is worth considering.

Thankfully the vast majority of patients are very happy with their outcome post total knee replacement and the impact can significantly improve quality of life. Appropriate education and early engagement with suitably qualified healthcare professionals, pre and post-surgery, can significantly improve the chances of a favourable outcome for your father.

Have a question for the professionals you’d like answered? Get in touch with sarah.gill@image.ie with the subject headline ‘Ask The Doctor’.